Misoprostol and Chlorhexidine: Saving Mothers and Babies in Nigeria

Over the last three years, policymakers have invested in low-cost drugs that are saving the lives of mothers and babies.

The distribution of misoprostol and chlorhexidine (CHX)—used respectively to prevent postpartum hemorrhage and newborn sepsis, the leading causes of maternal and neonatal mortality—has the potential to save thousands of Nigerian mothers and babies each year.

Poor health outcomes in rural communities of Bauchi and Sokoto contribute to high rates of maternal mortality (roughly 1,500/100,000 live births) and mortality of children under the age of five (approximately 269/1000).

Cultural preference and low access to health services lead approximately 95 percent of women in the two northern Nigerian states to deliver their babies at home. Of these, in 2008, an astounding 34% of women in Bauchi—20 percent country wide—delivered their babies alone. Under these conditions, common complications during childbirth are life-threatening for both mothers and babies.

JSI’s Targeted States High Impact Project (TSHIP) identified misoprostol and chlorhexidine as high-impact solutions with the potential to drive down maternal and newborn deaths in Bauchi and Sokoto. But, for the interventions to succeed, the project needed the buy-in and cooperation of stakeholders at every level, from state government to individual households.

Leveraging the success of the JSI-implemented chlorhexidine program in Nepal, TSHIP convinced state Ministers of Health of the potential of the interventions to save lives in northern Nigeria. The project also advocated for the distribution of chlorhexidine and misoprostol as a pair to the households of laboring women to maximize efficiency and impact.

TSHIP also advocated for chlorhexidine and misoprostol with Ward Development Committees (WDCs, local administrative bodies) and religious leaders, to encourage key decision makers and influencers to raise awareness around the intervention and the importance of improving health outcomes for mothers and newborns.

The advocacy efforts paid off: in March 2013, Sokoto became the first government in Africa to procure chlorhexidine. (Sokoto procured the one-dose tubes from Lomus, a Nepalese pharmaceutical company that was already producing one-dose tubes for JSI’s pioneering CHX Navi Care program).

To get from the state medical stores to laboring women in remote villages, chlorhexidine and misoprostol are carefully distributed through each level of the health system: the drugs are shipped to Ward Development Committees, which distribute them down to local health facilities.

From there, chlorhexidine and misoprostol are distributed to community-appointed ‘drug keepers,’ who safeguard and monitor inventory at the village level. Trained community health volunteers, who provide health information and services at the household level, identify and track pregnant women in their villages, and deliver the drugs from the drug keeper to laboring women in their homes.

By January 2014, this system had delivered chlorhexidine and misoprostol to 56,000 mother/newborn pairs in all of Sokoto’s 244 wards. TSHIP and its partners successfully advocated for the inclusion of the two drugs in the essential medicines lists at state and national levels, and trained community-level volunteers to deliver misoprostol and CHX as part of their integrated, high-impact maternal, newborn, and child health interventions.

Misoprostol has reached mothers in labor in all 244 wards in Sokoto State. 70,982 women—or 22% of expected births—received misoprostol between April 2013 to December 2014.

So far, more than one million mother-newborn pairs in Nigeria have benefited from misoprostol and chlorhexidine. Furthermore, the number of women delivering alone has declined from 34% in 2008 to 21.2% in Bauchi; in Sokoto it went from 25.2% to <1%